The pivotal role of central sensitization in long COVID, fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome
Don L. Goldenberg
Introduction
Long COVID is a condition characterized by persistent unexplained symptoms following COVID-19 infection. These symptoms are not related to another disease or organ damage and are similar to those in fibromyalgia and myslgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Areas Covered
The similar clinical and pathophysiological features and management of long COVID, fibromyalgia and ME/CFS are explored from the unifying framework of central sensitivity syndromes. The article is based on a literature search utilizing PubMed for content published between 2021 and 1 May 2025, using search terms: long COVID, long COVID syndrome, post-COVID-19, post-acute SARS-CoV-2, fibromyalgia, ME/CFS, post-exertional malaise and central sensitization.
Expert opinion
Once long COVID is redefined to exclude patients with well-defined organ disease, it fits best as a model of central sensitization. Long COVID is a single syndrome, rather than many distinct diseases. Optimal management of long COVID and similar central sensitivity syndromes should include personalized care with a primary care led-multidisciplinary team.
Article highlights
* Long COVID should be restricted to patients with persistent, unexplained symptoms after mild-moderate SARS-CoV-2 infection, who have had no organ damage or disease biomarkers.
* The symptoms and clinical course of long COVID are similar to those of FM and ME/CFS and fit best as a model of central sensitization.
* SARS-Cov-2 triggers long COVID but is not the direct cause of its chronic symptoms; long COVID is a post-infectious syndrome.
* Rather than a systemic immune disease, long COVID, like ME/CFS and FM, is a neuroimmune illness, manifest by functional abnormalities in the central and autonomic nervous systems.
* Management of long COVID, similar to that of ME/CFS and FM, should focus on an individualized, multidisciplinary program that includes patient education and counseling, carefully incremental activity and exercise, and cognitive behavior therapy.
Link (Expert Review of Neurotherapeutics) [Paywall]
Don L. Goldenberg
Introduction
Long COVID is a condition characterized by persistent unexplained symptoms following COVID-19 infection. These symptoms are not related to another disease or organ damage and are similar to those in fibromyalgia and myslgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Areas Covered
The similar clinical and pathophysiological features and management of long COVID, fibromyalgia and ME/CFS are explored from the unifying framework of central sensitivity syndromes. The article is based on a literature search utilizing PubMed for content published between 2021 and 1 May 2025, using search terms: long COVID, long COVID syndrome, post-COVID-19, post-acute SARS-CoV-2, fibromyalgia, ME/CFS, post-exertional malaise and central sensitization.
Expert opinion
Once long COVID is redefined to exclude patients with well-defined organ disease, it fits best as a model of central sensitization. Long COVID is a single syndrome, rather than many distinct diseases. Optimal management of long COVID and similar central sensitivity syndromes should include personalized care with a primary care led-multidisciplinary team.
Article highlights
* Long COVID should be restricted to patients with persistent, unexplained symptoms after mild-moderate SARS-CoV-2 infection, who have had no organ damage or disease biomarkers.
* The symptoms and clinical course of long COVID are similar to those of FM and ME/CFS and fit best as a model of central sensitization.
* SARS-Cov-2 triggers long COVID but is not the direct cause of its chronic symptoms; long COVID is a post-infectious syndrome.
* Rather than a systemic immune disease, long COVID, like ME/CFS and FM, is a neuroimmune illness, manifest by functional abnormalities in the central and autonomic nervous systems.
* Management of long COVID, similar to that of ME/CFS and FM, should focus on an individualized, multidisciplinary program that includes patient education and counseling, carefully incremental activity and exercise, and cognitive behavior therapy.
Link (Expert Review of Neurotherapeutics) [Paywall]
